Deceleration Capacity Improves Prognostic Accuracy of Relative Increase and Final Coronary Physiology in Patients With Non-ST-Elevation Acute Coronary Syndrome

Frontiers in Cardiovascular Medicine

article

Jun Wang¹  Chengzhe Liu¹  Fuding Guo¹  Zhen Zhou¹  Liping Zhou¹  Yueyi Wang¹  Huaqiang Chen¹  Huixin Zhou¹  Zhihao Liu¹  Shoupeng Duan¹  Ji Sun¹  Qiang Deng¹  Saiting Xu¹  Hong Jiang¹  Lilei Yu¹ 

[1] Department of Cardiology, Renmin Hospital of Wuhan University;Cardiac Autonomic Nervous System Research Centre of Wuhan University;Cardiovascular Research Institute, Wuhan University;Hubei Key Laboratory of Cardiology

关键词: deceleration capacity;    non-ST-elevation acute coronary syndrome (NSTE-ACS);    coronary physiology;    major adverse cardiac and cerebrovascular events (MACCEs);    quantitative flow ratio (QFR);   

DOI  :  10.3389/fcvm.2022.848499

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Background Both coronary physiology and deceleration capacity (DC) showed prognostic efficacy for patients with acute coronary syndrome (ACS). This retrospective cohort study was performed to evaluate the prognostic implication of DC combined with the relative increase and final coronary physiology as detected by quantitative flow ratio (QFR) for patients with non-ST-elevation ACS (NSTE-ACS) who underwent complete and successful percutaneous coronary intervention (PCI). Methods Patients with NSTE-ACS who underwent PCI with pre- and post-procedural QFR in our department between January 2018 and November 2019 were included. The 24-hour deceleration capacity (DC 24h) was obtained via Holter monitoring. The incidence of major adverse cardiac and cerebrovascular events (MACCEs) during follow up was defined as the primary outcome. The optimal cutoffs of the relative increase, final QFR, and DC 24h for prediction of MACCEs were determined via receiver operating characteristic (ROC) analysis and the predictive efficacies were evaluated with multivariate Cox regression analysis. Results Overall, 240 patients were included. During a mean follow up of 21.3 months, 31 patients had MACCEs. Results of multivariate Cox regression analyses showed that a higher post-PCI QFR [adjusted hazard ratio (HR): 0.318; 95% confidence interval (CI): 0.129–0.780], a higher relative QFR increase (HR: 0.161; 95% CI: 0.066–0.391], and a higher DC (HR: 0.306; 95% CI: 0.134–0.701) were all independent predictors of lower risk of MACCEs. Subsequently, incorporating low DC (≤2.42) into the risk predicting model with clinical variables, the predictive efficacies of low relative QRS increase (≤23%) and low post-PCI QFR (≤0.88) for MACCEs were both significantly improved. Conclusions The DC combined with relative increase and final coronary physiology may improve the predictive efficacy of existing models based on clinical variables for MACCEs in NSTE-ACS patients who underwent complete and successful PCI.

【 授权许可】

CC BY